Background: Women, especially those older than 65 years, wait longer than men before seeking treatment for Acute Coronary Syndrome.The most significant reasons for treatment delay in women are atypical symptoms, failure to correctly attribute symptoms to the heart, perceived severity and seriousness of symptoms, confusion of acute symptoms with other chronic illness and low self-perceived vulnerability to heart attack.Door to balloon time (DTBT) is a key indicator of quality of care for ST-Elevation Myocardial Infarction (STEMI) patients who receive primary PCI.The National Heart Foundation of Australia guidelines recommend a DTBT of-3d 90 minutes.The goal of this evaluation was to identify the difference in DTBT between men and women presenting with STEMI at Austin Health over a 42 month period during a 2 phase quality improvement process to improve DTBT.Method: An analysis of time specific data was performed on 342 consecutive STEMI patients that presented to the Emergency Department (ED) at Austin Health over a 42 month period.Inter-hospital and inter-departmental STEMI cases were excluded.During this time frame a 2 phase quality improvement program was implemented to improve DTBT.Results: There were 342 patients in this 42 month period, 79 (23%) women and 263 (77%) men.The mean age was 70years (+/-13) for women and 61 years (+/-13) for men.10% of women and 7% of men had no chest pain on presentation.6.3% of women and 6.1% of men were intubated prior to arriving in the emergency department.The median length of stay in hospital for women was 5 days (1-52 days) and 4 days (1-37) for men.The 30 day mortality was 7.6% for women and 6.4% for men.The median DTBT for this period was 105 minutes for women (31-295minutes) and 88 minutes (18-700 minutes) for men.The total median DTBT for both groups was further analyzed to include the timeframes for the 2 phase roll out of the quality improvement program.The total median DTBT for the 2 groups were 109 mins, 77 mins and 76 mins respectively, a reduction of 33 mins (median).The DTBTs for women vs men during the 2 phase roll out was 116mins pre roll out for women and 105 mins for men, 97 mins post phase 1 for women and 73 minutes for men and 91 mins post phase 2 for women and 71 minutes for men.Conclusion: Despite significant improvement in the DTBT during the rollout of the 2 phase quality improvement process women continued to have poorer DTBTs than men contributing to a comparative increase in increased length of stay and 30 day mortality.